California School of Professional Psychology At Alliant International University One Beach Street, Suite 100 San Francisco, CA 94133 (415) 955-2100 Cognitive-Behavioral Therapy: Theory and Practice PSY 7504 California School of Professional Psychology Fall 2009 San Francisco Campus Thursdays 6:10pm – 9:00pm Andrew Bertagnolli, PhD andrew.bertagnolli@kp.org- - - (510) 271-5771 Office Hours:by appointment Grading options: Letter grade
I. Rationale: Cognitive Behavioral Therapy (CBT) is a psychotherapy based on modifying cognitions, assumptions, beliefs and behaviors, with the aim of influencing disturbed emotions. The general approach developed out of behavior modification, Cognitive Therapy and Rational Emotive Behavior Therapy, have become widely used to treat various kinds of neurosis and psychopathology, including mood disorders and anxiety disorders. The particular therapeutic techniques vary according to the particular kind of client or issue, but commonly include keeping a diary of significant events and associated feelings, thoughts and behaviors; questioning and testing cognitions, assumptions, evaluations and beliefs that might be unhelpful and unrealistic; gradually facing activities which may have been avoided; and trying out new ways of behaving and reacting. Relaxation and distraction techniques are also commonly included. CBT is widely accepted as an evidence and empirically based, cost-effective psychotherapy for many disorders and psychological problems. It is sometimes used with groups of people as well as individuals, and the techniques are also commonly adapted for self-help manuals and, increasingly, for self-help software packages. II. Course Description, Purpose, Student Learning Outcomes and Assessment: A.Course Description This course begins with an overview of conceptual foundations underlying behavioral and cognitive approaches to assessment and treatment. We will proceed to examine several techniques associated with the Cognitive-Behavioral spectrum, including schema analysis and other cognitive formulations, cognitive restructuring, and (toward the more behavioral end of the spectrum), functional analysis, exposure treatment, and contingency management. Students will be introduced to CBT protocols for treatment of depression, various anxiety disorders, and personality disorders. Throughout, we will attend to the conceptualization and role of the therapeutic relationship in CBT. B. Purpose of the Course The purpose of this course is to introduce students to Cognitive-Behavioral Theory and Technique. Cognitive-Behavioral Therapy (CBT) is an empirically supported treatment that focuses on patterns of thinking that are maladaptive and the beliefs that underlie such thinking. For example, a person who is depressed may have the belief, "I’m worthless," and a person with a phobia may have the belief, "I am in danger." While the person in distress likely holds such beliefs with great conviction, with a therapist’s help, the individual is encouraged to view such beliefs as hypotheses rather than facts and to test out such beliefs by running experiments. Furthermore, those in distress are encouraged to monitor and log thoughts that pop into their minds (called "automatic thoughts") in order to enable them to determine what patterns of biases in thinking may exist and to develop more adaptive alternatives to their thoughts. People who seek CBT can expect their therapist to be active, problem-focused, and goal-directed. Studies of CBT have demonstrated its usefulness for a wide variety of problems, including mood disorders, anxiety disorders, personality disorders, eating disorders, substance abuse disorders, and psychotic disorders. C. Specific Learning Outcomes: Specifically, upon completion of the course, students will be: 1)Discuss the theory of cognitive-behavioral therapy 2)Apply the principles of cognitive-behavioral therapy to a cohesive case formulation 3)Select and modify interventions based on the patient's presenting problem, cultural background, life situation, education level and time constraints D. Instructional Strategy Lecture & Discussion E. Class Component on Multicultural and International Issues This class assumes incorporation of critical and informed examination of multicultural issues on psychotherapy process and outcome and on individual development. International perspectives in the course are focused on the psychological experience of immigration, including the experiences of terrorism, trauma, and separation from the “mother” country.Cross-cultural therapy and differences between therapist and client will be explored. Readings, class discussion and assignments address these issues. F. Description of Course Requirements and Assessment Methods Since the goal of this class is to be able to treat a case from a cognitive-behavioral perspective, the assignment is to provide a cognitive-behavioral case formulation for a case that you are currently treating or have treated in the past.The case formulation should include the following sections: 1. Identifying Information 2. Problem List 3. Proposed underlying mechanisms (schema hypotheses) 4. How the mechanisms fuel the problems 5. Current precipitants 6. Origins of the mechanisms 7. Proposed interventions 8. Predicted obstacles to treatment based on the formulation There are not a specific number of pages for this paper needs to be. It should be complete and thorough. It you can do this in a concise manner that's great. If it takes you a few more pages than the next person, that's okay.Create a formulation that would be useful to a treating psychologist to whom you may be transferring the case Case Formulation papers are to be typed - handwritten papers will not be accepted. Additional information can be found in Appendix C Part II. Emphasis throughout the course will be on application of cognitive behavioral theory to real life patients and situations. Seminar Discussions 40% Written Assignments 60% III. Course Readings and Materials: ·Course readings: Main Text: Persons, J. (2008). The Case Formulation Approach to Cognitive Behavioral Therapy. New York: Guilford Articles are available at:http://www.4shared.com/dir/7524049/61653c29/sharing.html The password is andrew. IV. Policies and Procedures: Behavioral Expectations/Attendance 1.Policies Related To Class Attendance, Lateness, Missed Exams or Assignments The University expects regular class attendance by all students.Each student is responsible for all academic work missed during absences.When an absence is necessary, students should contact the instructor as courtesy and to check for assignments.See the University Catalog for the complete policy on attendance (http://www2.alliant.edu/download/2005/catalog/3_Academic_Policies.pdf). 2.Responsibility to Keep Copies Remember – it is good practice to keep copies of ALL major assignments/papers you turn in.On rare occasions, work may be lost because of computer failure or other mishaps. 3.Respectful Speech and Actions Alliant International University, by mission and practice, is committed to fair and respectful consideration of all members of our community, and the greater communities surrounding us.All members of the University must treat one another as they would wish to be treated themselves, with dignity and concern. As an institution of higher education, Alliant International University has the obligation to combat racism, sexism, and other forms of bias and to provide an equal educational opportunity. Professional codes of ethics (e.g., from the APA for psychology students) and the Academic Code shall be the guiding principles in dealing with speech or actions that, when considered objectively, are abusive and insulting. 4.Academic Code of Conduct and Ethics The University is committed to principles of scholastic honesty.Its members are expected to abide by ethical standards both in their conduct and in their exercise of responsibility towards other members of the community.Each student’s conduct is expected to be in accordance with the standards of the University.The complete Academic Code, which covers acts of misconduct including assistance during examination, fabrication of data, plagiarism, unauthorized collaboration, and assisting other students in acts of misconduct, among others, may be found in the University Catalog.The University reserves the right to use plagiarism detection software. 5.Evaluation of Students’ Professional Development and Functioning In CSPP, multiple aspects of students’ professional development and functioning (e.g., cognitive, emotional, psychological, interpersonal, technical, and ethical) will be evaluated throughout the process of education and training in our professional psychology and MFT programs.This kind of comprehensive evaluation is necessary in order for faculty, staff, and supervisors to appraise the professional development and competence of their students.See the University Catalog for the complete CSPP policy on “Evaluation of Student Competence: A. Student Disclosure of Personal Information” (Appendix B). 6.Disability Accommodations Request If you need disability-related accommodations in this class, please see me privately.All accommodations must be requested in a timely manner (at least 2 weeks ahead of time) with a letter of support for Alliant’s Office of Disability Services.If you have questions about accommodations, please contact the Office of Disability Services. 7.Policy on Course Requirements During Religious Holidays Alliant International University does not officially observe any religious holidays.However, in keeping with the institution’s commitment to issues of cultural diversity as well as humanitarian considerations, faculty are encouraged to appreciate students’ religious observances by not penalizing them when they are absent from classes on holy days.Alliant International University faculty will be sensitive to these matters.Students should be similarly respectful of faculty members’ right to observe religious days. 8.Resources for Obtaining Tutoring or Other Student Support Services Tutors are available to help students with course-based or exam-based needs. Contact the Director of Student Support Services for information on obtaining tutoring – or other student support services – on your campus. 9.Problem Solving Resources If problems arise with faculty, other students, staff, or student support services, students should use the University Problem Solving Procedures located on the web at http://www.alliant.edu/academic/studentproblemsolving/Student_Grievance_Policy.pdf or contact the University Ombudsperson at rkunard@alliant.edu. V.Course Schedule: Reminder that Syllabus is Subject to Change The following is the general structure and content of the course.Students should remember that the exact content and schedule of the syllabus is subject to change without prior notice to meet student, faculty, or other needs.We may spend more time on some topics as needed, and conversely, may move more quickly over other topics. Class Schedule & Assignments
Date
Topic
Readings
File Names
September 3
Introduction & Review of Theories
Main Text Chapters 2, 3 & 4
September 10
Introduction to the Cognitive Behavioral Model
Persons, J., Curtis, J., & Silberschatz, G. (1991). Psychodynamic and cognitive-behavioral formulations of a single case. Psychotherapy, 28(4), 608-617. Persons, J., & Bertagnolli, A. (1994). Cognitive-behavioral treatment of multiple-problem patients: Application to personality disorders.Clinical Psychology and Psychotherapy, 1(5), 279-285. Persons, J., Gross, J., Etkin, M., & Madan, S. (1996).Psychodynamic therapists' reservations about cognitive behavioral therapy.Journal of Psychotherapy Practice and Research, 5(3), 202-212.
Assignment:Identifying Information for your case, due September 24th.
September 17
NO CLASS
September 24
Introduction to Case Formulation
Main Text Chapter 1 Persons, J. (1993). Case conceptualization in cognitive-behavior therapy.In K. Kuehlwein & H. Rosen (Eds.), Cognitive Therapies in Action, (pp. 33-53). San Francisco: Jossey-Bass. Needleman, LD (1991) Cognitive Case Conceptualization:A Guidebook for Practitioners, (pp. 1-21). New Jersey: Lawrence Earlbaum Associates. Persons, J., & Bertagnolli, A. (1994). Cognitive-behavioral treatment of multiple-problem patients: Application to personality disorders.Clinical Psychology and Psychotherapy, 1(5), 279-285.
CBT Assessment: Problem List Formulation & Schema Hypotheses
Main Text Chapters 5 & 6 Case Reports: "Q" Case, "Jill" Case, "Jose" Case, "VAMC" Case Okazaki, S & Tanaka-Matsumi, J (2006) Cultural Considerations in Cognitive-Behavioral Assessment. In Hays, P & Iwamasa, G (Eds.) Culturally Responsive Cognitive-Behavioral Therapy. (pp. 247-266). Washington, DC: American Psychological Association.
Assignment:Create schema hypotheses and underlying assumptions for your case, due October 22nd.
October 15
NO CLASS
October 22
Socratic Dialogue
Main Text Chapter 11 Padesky, C. (1993). Socratic Questioning: Changing Minds or Guiding Discovery?Paper presented at the European Congress of Behavioural and Cognitive Therapies, London, UK. - - Overholser, J. (1993). Elements of the Socratic method: Inductive reasoning. Psychotherapy, 30(1), 75-85. - - Overholser, J. (1993).Elements of the Socratic Method: Systematic questioning. Psychotherapy, 30(1), 67-74.
Assignment:How the mechanisms fuel the problems & current precipitants for your case, due October 29th.
October 29
Overview of The Juvenile Criminal Justice System: Public Defender’s Point of View
Guest Speaker: Stephen Zollman, Esq. San Francisco Public Defenders Office
grisso_forensic_evaluation_juveniles.pdf
NOTE: TUESDAY November 3 – NO CLASS November 5
Application to OCD & Panic DO
Needleman, LD (1991) Cognitive Case Conceptualization:A Guidebook for Practitioners, (pp. 182-236). New Jersey: Lawrence Earlbaum Associates. Needleman, LD (1991) Cognitive Case Conceptualization:A Guidebook for Practitioners, (pp. 123-181). New Jersey: Lawrence Earlbaum Associates.
needleman_ocd.pdf. neddleman_panic.pdf
NOTE: TUESDAY November 10 – NO CLASS November 12
Application to Obesity & Bulimia
Williamson, D, Muller, S, Reas, D & Thaw, J (1999). Cognitive bias in eating disorders:Implications for theory and treatment, Behavior Modification, 23(4):556-577. Spangler, D (1999). Cognitive-behavioral therapy for bulimia nervosa:An illustration, Journal of Clinical Psychology, 55(6):699-713. - Craighead & Kirkley (1994). Obesity and Eating Disorders. In Craighead, Craighead, Kazdin & Mahoney (eds.) Cognitive and Behavioral Interventions. Allyn and Bacon: Boston. (pps. 141-155). Agras, Walsh, Fairburn, Wilson, & Kramer (2000) A multicenter comparison of cognitive-behavioral therapy and interpersonal psychotherapy for bulimia nervosa. Archives of General Psychiatry, 57, 459-466. Halmi, Agras, Mitchell, Wilson, Crow, Bryson, & Kramer (2002) Relapse predictors of patients with bulimia nervosa who achieved abstinence through cognitive-behavioral therapy. Archives of General Psychiatry, 59, 1105-1109.
Assignment:Origins of the mechanisms section for your case, due November 19th.
November 19
CB – Intervention – Part 1
Main Text Chapter 7 Craighead, Craighead, Kazdin & Mahoney (1994) Principles of Behavioral and Cognitive Change. Cognitive and Behavioral Interventions. Allyn and Bacon: Boston (pgs 29-46). Leahy, R ( 2003) Examining and Challenging Cognitive Distortions. Cognitive Therapy Techniques. New York: Guilford. (pgs 292-305).
Assignment:Proposed interventions section for your case due August 7th.
December 10
Application to Substance Abuse
Beck, A, Wright, F, Newman, C & Liese, B (1993), Cognitive Therapy of Substance Abuse. (22-41). Beck, A, Wright, F, Newman, C & Liese, B (1993), Cognitive Therapy of Substance Abuse. (42-53).
beck_cog_model_addiction.pdf beck_addiction.pdf
Assignment:Entire case formulation for your case, due August 14th.
December 17
Application to Personality Disorders
Beck, AT, Freeman, A, Davis, DD & Associates. (2004). Cognitive Therapy of Personality Disorders, (pp. 17-51). New York: Guilford Press. Beck, AT, Freeman, A, Davis, DD & Associates. (2004). Cognitive Therapy of Personality Disorders, (pp. 69-91). New York: Guilford Press.
Academic Standing Status for CSPP Doctoral Students
Use the following grade equivalencies to translate campus based to CSPP systems. A & B = Credit with no “some concerns” or no “serious concerns” C = marginal pass or “some concerns” D/F = fail or “serious concerns” In the following, substitute the grade equivalencies from above. Good Academic Standing – Any record of performance which does not qualify for Warning, Probation, Termination, or all A and B’s. Warning – One grade of C or lower Probation – (a) In the first 60 units of the program: Two C’s OR one C and one D/F. (b) During the entire program: Three C’s OR one D/F and one C Termination – Students will be terminated from the program if their GPA falls below a 3.0 or if they are on probation for 2 terms.
Related Issues:
1.Students placed on academic warning or probation status will return to good standing upon receiving of all A/B’s in the semester following the semester which qualified the person for warning/probation status. 2.Students must repeat a course for which a no credit grade is received.Both grades will remain on the transcript. 3.Students may be placed on warning, probation, or terminated for other performance, ethical or professional behavior, such as acts of misconduct, unprofessional behavior, failure to complete 67% of the units attempted every academic year, failure to complete their educational program within a reasonable period of time, or failure to pass comprehensive, preliminary, or other competency exams (Please refer to local program and system-wide polices). 4.A student may be required to take a mandatory leave of absence, a modified sequence or reduced load of courses, or to repeat or take additional courses if their academic work or professional development requires serious remediation. Appendix B Student Disclosure of Personal Information (Adapted from the Student Competence Task Force of the Council of Chairs of Training Councils (CCTC), http://www.apa.org/ed/graduate/cctc.html, December 4, 2003) Professional helpers are expected to demonstrate competence within and across a number of different but interrelated dimensions.Because programs that educate and train professional helpers also strive to protect the public and profession, faculty, training staff, and supervisors in such programs have a legitimate and vested interest in the comprehensive evaluation of student competence to include multiple aspects of development and functioning (e.g., cognitive, emotional, psychological, interpersonal, technical, and ethical). In CSPP, multiple aspects of students’ professional development and functioning (e.g., cognitive, emotional, psychological, interpersonal, technical, and ethical) will be evaluated throughout the process of education and training in our professional psychology and MFT programs.This kind of comprehensive evaluation is necessary in order for faculty, staff, and supervisors to appraise the professional development and competence of their students. Faculty, staff, and supervisors have a professional, ethical, and potentially legal obligation to: (a) evaluate the interpersonal competence and emotional well being of student trainees who are under their supervision, and who provide services to clients and consumers, and (b) ensure—insofar as possible—that the trainees who complete their programs are competent to manage future relationships (e.g., client, collegial, professional, public, scholarly, supervisory, and teaching) in an effective and appropriate manner. Faculty, staff, and supervisors will evaluate student competence in areas other than coursework, seminars, scholarship, comprehensive examinations, or related program requirements.Students may therefore be required to participate in learning activities that require different levels of self-disclosure.These multiple evaluative areas include, but are not limited to, demonstration of sufficient: (a) interpersonal and professional competence (e.g., the ways in which students relate to clients, peers, faculty, allied professionals, the public, and individuals from diverse backgrounds or histories); (b) self-awareness, self-reflection, and self-evaluation (e.g., knowledge of the content and potential impact of one's own beliefs and values on clients, peers, faculty, allied professionals, the public, and individuals from diverse backgrounds or histories); (c) openness to processes of supervision (e.g., the ability and willingness to explore issues that either interfere with the appropriate provision of care or impede professional development or functioning); and (d) resolution of problems or issues that interfere with professional development or functioning in a satisfactory manner (e.g., by responding constructively to feedback from supervisors or program faculty; by participating in personal therapy in order to resolve problems or issues). Appendix C I. Class Participation Grading Criteria 1. Attendance:
This is a cooperative learning class. That means that your absence affects the learning of others. In general, missing more than 2 classes will affect your class participation grade. Class participation includes actively participating in class including being adequately prepared. Your grade for class participation will be based on attendance and your good faith participation in the discussion. Being repeatedly distracted or inattentive will lower your grade. 2. Participation Examples:
Maximal Participation: Student is thoroughly prepared, contributed readily to the conversation (usually a couple of comments) but didn't dominate it; made thoughtful contributions that significantly advance the conversation (comments beyond a repeat of factual information); showed interest in and respect for other views; participated actively in small groups; raised issues related to the topic at hand, challenges participants to think about the material in new ways. Above Average Participation: Student is prepared and makes thoughtful comments if called on; contributes occasionally without prompting; shows interest in and respect for others’ views; participates actively in small groups; while the student’s contributions are less well developed, they nevertheless advance the conversation; raised issues related to the topic at hand. Average Participation: Student is prepared, but does not voluntarily contribute to discussions and gives only minimal answers if called on; nevertheless student show interest in the discussion, listens attentively and participates actively in small groups. 3. Types of In-Class Contributions In general comments in the latter 2 categories will have greater value. Fact: A statement indicating recall of the text material. Elaboration: A comment indicating assimilation of information and ability to draw inferences, and connections between topics. Insight: A comment suggesting penetrating discernment and understanding of the material as it relates to one’s self as a developing psychologist, a client, or the practice of psychology. II. Case Write-Up Grading Criteria 1. Background Information
The first section of your paper will present your client’s background. Include factors such as age, gender, work, health status, family mental health history, family and social relationships, drug and alcohol history, goals, and coping skills and weaknesses.
2. Description of the Presenting Problems (aka: Problem List)
In the next section of your case study, you will describe the problem or symptoms that the client presented with. Describe any physical, emotional, or sensory symptoms reported by the client.Automatic thoughts, feelings, and behaviors associated with each problem should also be noted.Any screening or diagnostic assessments that are used should also be described in and all scores reported.Avoid diagnostic labels or historical events as problems on the problem list.Rather explain, how the historical event causing problems for the client currently.
3. Your Diagnosis
Provide your diagnosis using the appropriate DSM-IV terminology. It should be clear from the problem list how you reached your diagnosis, how the client’s symptoms fit the diagnostic criteria for the disorder(s), or any possible difficulties in reaching a diagnosis. 4. Your Formulation
Explain how a cognitive-behavioral psychologist would approach treatment. Explain how the client’s particular cognitive mechanisms; schemas (core beliefs), underlying assumptions (‘rules for living’) and behavioral mechanisms (compensatory strategies) interact with their environment in ways that generate the difficulties detailed in the problem list. Detail relevant history regarding development and maintenance of cognitive mechanisms and compensatory strategies, including how aspects of client’s environment reinforced or buffered them.Avoid providing a biographical epic, try and link each factoid to a cognitive mechanism or compensatory strategy. Include impact of culture, gender, religion, sexual-orientation, SES, etc. on development and maintenance of these cognitive structures and behavioral responses. Also include any obstacles to treatment based upon the formulation and your proposal to address or deal with them.
5. Treatment Plan
Provide a reasoned treatment plan.Be specific as to what types of interventions you propose to start with (eg: behavioral activation, cognitive restructuring, relaxation training, etc.) be sure to provide a rationale that is grounded in your formulation and cognitive-behavioral theory.Make note of expected client response and what markers would you use to gauge treatment effectiveness and when you might introduce other techniques.Also include any adjunctive treatment you might recommend and rationale as to why. Make note of any difficulties you hypothesize may be encountered by your client during treatment, tie these back to your formulation.Also discuss any adaptation or modification to standard cognitive-behavioral interventions or the session structure needed to address cultural or other issues.These should be based on your formulation. 6. Timeliness
All assignments are due by on the last class date in the syllabus.Submission can either be in person or via email.Late assignments will be accepted but will impact overall grade.When submitting by email, be sure that you receive a response from me to ensure that I have received it.The response will either be a “got it…thanks” or an automated response from my email indicating that I am out of the office and my return date. Please let me know if you are having difficulty in completing assignments on time, alternate arrangements can be made.
7. Grammar and Formatting
All assignments are expected to be typed and free from grammatical errors.Please put your name and page number in the header on each page. 8. Term Paper Examples are Available Sample term papers can be found at:http://www.4shared.com/dir/7524049/61653c29/sharing.html The password is andrew. sample_term_paper_a.pdf; sample_term_paper_harry.pdf; sample_term_paper_l.pdf; sample_term_paper_sylvia.pdf
At Alliant International University
One Beach Street, Suite 100
San Francisco, CA 94133
(415) 955-2100
Cognitive-Behavioral Therapy: Theory and Practice
PSY 7504
California School of Professional Psychology
Fall 2009
San Francisco Campus
Thursdays 6:10pm – 9:00pm
Andrew Bertagnolli, PhD
andrew.bertagnolli@kp.org - - - (510) 271-5771
Office Hours: by appointment
Grading options: Letter grade
I. Rationale:
Cognitive Behavioral Therapy (CBT) is a psychotherapy based on modifying cognitions, assumptions, beliefs and behaviors, with the aim of influencing disturbed emotions. The general approach developed out of behavior modification, Cognitive Therapy and Rational Emotive Behavior Therapy, have become widely used to treat various kinds of neurosis and psychopathology, including mood disorders and anxiety disorders. The particular therapeutic techniques vary according to the particular kind of client or issue, but commonly include keeping a diary of significant events and associated feelings, thoughts and behaviors; questioning and testing cognitions, assumptions, evaluations and beliefs that might be unhelpful and unrealistic; gradually facing activities which may have been avoided; and trying out new ways of behaving and reacting. Relaxation and distraction techniques are also commonly included. CBT is widely accepted as an evidence and empirically based, cost-effective psychotherapy for many disorders and psychological problems. It is sometimes used with groups of people as well as individuals, and the techniques are also commonly adapted for self-help manuals and, increasingly, for self-help software packages.
II. Course Description, Purpose, Student Learning Outcomes and Assessment:
A. Course Description
This course begins with an overview of conceptual foundations underlying behavioral and cognitive approaches to assessment and treatment. We will proceed to examine several techniques associated with the Cognitive-Behavioral spectrum, including schema analysis and other cognitive formulations, cognitive restructuring, and (toward the more behavioral end of the spectrum), functional analysis, exposure treatment, and contingency management. Students will be introduced to CBT protocols for treatment of depression, various anxiety disorders, and personality disorders. Throughout, we will attend to the conceptualization and role of the therapeutic relationship in CBT.
B. Purpose of the Course
The purpose of this course is to introduce students to Cognitive-Behavioral Theory and Technique. Cognitive-Behavioral Therapy (CBT) is an empirically supported treatment that focuses on patterns of thinking that are maladaptive and the beliefs that underlie such thinking. For example, a person who is depressed may have the belief, "I’m worthless," and a person with a phobia may have the belief, "I am in danger." While the person in distress likely holds such beliefs with great conviction, with a therapist’s help, the individual is encouraged to view such beliefs as hypotheses rather than facts and to test out such beliefs by running experiments. Furthermore, those in distress are encouraged to monitor and log thoughts that pop into their minds (called "automatic thoughts") in order to enable them to determine what patterns of biases in thinking may exist and to develop more adaptive alternatives to their thoughts. People who seek CBT can expect their therapist to be active, problem-focused, and goal-directed.
Studies of CBT have demonstrated its usefulness for a wide variety of problems, including mood disorders, anxiety disorders, personality disorders, eating disorders, substance abuse disorders, and psychotic disorders.
C. Specific Learning Outcomes:
Specifically, upon completion of the course, students will be:
1) Discuss the theory of cognitive-behavioral therapy
2) Apply the principles of cognitive-behavioral therapy to a cohesive case formulation
3) Select and modify interventions based on the patient's presenting problem, cultural background, life situation, education level and time constraints
D. Instructional Strategy
Lecture & Discussion
E. Class Component on Multicultural and International Issues
This class assumes incorporation of critical and informed examination of multicultural issues on psychotherapy process and outcome and on individual development. International perspectives in the course are focused on the psychological experience of immigration, including the experiences of terrorism, trauma, and separation from the “mother” country. Cross-cultural therapy and differences between therapist and client will be explored. Readings, class discussion and assignments address these issues.
F. Description of Course Requirements and Assessment Methods
Since the goal of this class is to be able to treat a case from a cognitive-behavioral perspective, the assignment is to provide a cognitive-behavioral case formulation for a case that you are currently treating or have treated in the past. The case formulation should include the following sections:
1. Identifying Information
2. Problem List
3. Proposed underlying mechanisms (schema hypotheses)
4. How the mechanisms fuel the problems
5. Current precipitants
6. Origins of the mechanisms
7. Proposed interventions
8. Predicted obstacles to treatment based on the formulation
There are not a specific number of pages for this paper needs to be. It should be complete and thorough. It you can do this in a concise manner that's great. If it takes you a few more pages than the next person, that's okay. Create a formulation that would be useful to a treating psychologist to whom you may be transferring the case
Case Formulation papers are to be typed - handwritten papers will not be accepted. Additional information can be found in Appendix C Part II.
Emphasis throughout the course will be on application of cognitive behavioral theory to real life patients and situations.
Seminar Discussions 40%
Written Assignments 60%
III. Course Readings and Materials:
· Course readings:
Main Text:
Persons, J. (2008). The Case Formulation Approach to Cognitive Behavioral Therapy. New York: Guilford
Articles are available at: http://www.4shared.com/dir/7524049/61653c29/sharing.html
The password is andrew.
IV. Policies and Procedures:
Behavioral Expectations/Attendance
1. Policies Related To Class Attendance, Lateness, Missed Exams or Assignments
The University expects regular class attendance by all students. Each student is responsible for all academic work missed during absences. When an absence is necessary, students should contact the instructor as courtesy and to check for assignments. See the University Catalog for the complete policy on attendance (http://www2.alliant.edu/download/2005/catalog/3_Academic_Policies.pdf).
2. Responsibility to Keep Copies
Remember – it is good practice to keep copies of ALL major assignments/papers you turn in. On rare occasions, work may be lost because of computer failure or other mishaps.
3. Respectful Speech and Actions
Alliant International University, by mission and practice, is committed to fair and respectful consideration of all members of our community, and the greater communities surrounding us. All members of the University must treat one another as they would wish to be treated themselves, with dignity and concern.
As an institution of higher education, Alliant International University has the obligation to combat racism, sexism, and other forms of bias and to provide an equal educational opportunity. Professional codes of ethics (e.g., from the APA for psychology students) and the Academic Code shall be the guiding principles in dealing with speech or actions that, when considered objectively, are abusive and insulting.
4. Academic Code of Conduct and Ethics
The University is committed to principles of scholastic honesty. Its members are expected to abide by ethical standards both in their conduct and in their exercise of responsibility towards other members of the community. Each student’s conduct is expected to be in accordance with the standards of the University. The complete Academic Code, which covers acts of misconduct including assistance during examination, fabrication of data, plagiarism, unauthorized collaboration, and assisting other students in acts of misconduct, among others, may be found in the University Catalog. The University reserves the right to use plagiarism detection software.
5. Evaluation of Students’ Professional Development and Functioning
In CSPP, multiple aspects of students’ professional development and functioning (e.g., cognitive, emotional, psychological, interpersonal, technical, and ethical) will be evaluated throughout the process of education and training in our professional psychology and MFT programs. This kind of comprehensive evaluation is necessary in order for faculty, staff, and supervisors to appraise the professional development and competence of their students. See the University Catalog for the complete CSPP policy on “Evaluation of Student Competence: A. Student Disclosure of Personal Information” (Appendix B).
6. Disability Accommodations Request
If you need disability-related accommodations in this class, please see me privately. All accommodations must be requested in a timely manner (at least 2 weeks ahead of time) with a letter of support for Alliant’s Office of Disability Services. If you have questions about accommodations, please contact the Office of Disability Services.
7. Policy on Course Requirements During Religious Holidays
Alliant International University does not officially observe any religious holidays. However, in keeping with the institution’s commitment to issues of cultural diversity as well as humanitarian considerations, faculty are encouraged to appreciate students’ religious observances by not penalizing them when they are absent from classes on holy days. Alliant International University faculty will be sensitive to these matters. Students should be similarly respectful of faculty members’ right to observe religious days.
8. Resources for Obtaining Tutoring or Other Student Support Services
Tutors are available to help students with course-based or exam-based needs. Contact the Director of Student Support Services for information on obtaining tutoring – or other student support services – on your campus.
9. Problem Solving Resources
If problems arise with faculty, other students, staff, or student support services, students should use the University Problem Solving Procedures located on the web at http://www.alliant.edu/academic/studentproblemsolving/Student_Grievance_Policy.pdf or contact the University Ombudsperson at rkunard@alliant.edu.
V. Course Schedule:
Reminder that Syllabus is Subject to Change
The following is the general structure and content of the course. Students should remember that the exact content and schedule of the syllabus is subject to change without prior notice to meet student, faculty, or other needs. We may spend more time on some topics as needed, and conversely, may move more quickly over other topics.
Class Schedule & Assignments
Persons, J., & Bertagnolli, A. (1994). Cognitive-behavioral treatment of multiple-problem patients: Application to personality disorders. Clinical Psychology and Psychotherapy, 1(5), 279-285.
Persons, J., Gross, J., Etkin, M., & Madan, S. (1996). Psychodynamic therapists' reservations about cognitive behavioral therapy. Journal of Psychotherapy Practice and Research, 5(3), 202-212.
persons_cbt_multiple_problems.pdf
persons_psychodynamic_therapist_reservations.pdf
Persons, J. (1993). Case conceptualization in cognitive-behavior therapy. In K. Kuehlwein & H. Rosen (Eds.), Cognitive Therapies in Action, (pp. 33-53). San Francisco: Jossey-Bass.
Needleman, LD (1991) Cognitive Case Conceptualization: A Guidebook for Practitioners, (pp. 1-21). New Jersey: Lawrence Earlbaum Associates.
Persons, J., & Bertagnolli, A. (1994). Cognitive-behavioral treatment of multiple-problem patients: Application to personality disorders. Clinical Psychology and Psychotherapy, 1(5), 279-285.
needleman_intro_case_concept.pdf
persons_cbt_multiple_problems.pdf
Case Reports: "Q" Case, "Jill" Case, "Jose" Case, "VAMC" Case
Okazaki, S & Tanaka-Matsumi, J (2006) Cultural Considerations in Cognitive-Behavioral Assessment. In Hays, P & Iwamasa, G (Eds.) Culturally Responsive Cognitive-Behavioral Therapy. (pp. 247-266). Washington, DC: American Psychological Association.
hatzis_case_jill.pdf
bertagnolli_case_jose.pdf
bertagnolli_case_vamc.pdf
okazaki_cultural_considerations.pdf
Beck, AT, Freeman, A, Davis, DD & Associates. (2004). Cognitive Therapy of Personality Disorders, (pp. 92-112). New York: Guilford Press.
Needleman, LD (1991) Cognitive Case Conceptualization: A Guidebook for Practitioners, (pp. 53-62). New Jersey: Lawrence Earlbaum Associates.
Beck, J (2005) Therapeutic Relationship Problems: Case Examples. Cognitive Therapy for Challenging Problems, (pp. 91-111). New York: Guilford Press.
needleman_the_therapeutic_relationship_p1 needleman_the_therapeutic_relationship_p2
beck_therapeutic_relationship_problems.pdf
Padesky, C. (1993). Socratic Questioning: Changing Minds or Guiding Discovery? Paper presented at the European Congress of Behavioural and Cognitive Therapies, London, UK. - -
Overholser, J. (1993). Elements of the Socratic method: Inductive reasoning. Psychotherapy, 30(1), 75-85. - -
Overholser, J. (1993). Elements of the Socratic Method: Systematic questioning. Psychotherapy, 30(1), 67-74.
overholser_elements_inductive_reasoning.pdf
overholser_elements_systematic_questioning.pdf
due October 29th.
Point of View
San Francisco Public Defenders Office
Needleman, LD (1991) Cognitive Case Conceptualization: A Guidebook for Practitioners, (pp. 123-181). New Jersey: Lawrence Earlbaum Associates.
neddleman_panic.pdf
Spangler, D (1999). Cognitive-behavioral therapy for bulimia nervosa: An illustration, Journal of Clinical Psychology, 55(6): 699-713. -
Craighead & Kirkley (1994). Obesity and Eating Disorders. In Craighead, Craighead, Kazdin & Mahoney (eds.) Cognitive and Behavioral Interventions. Allyn and Bacon: Boston. (pps. 141-155).
Agras, Walsh, Fairburn, Wilson, & Kramer (2000) A multicenter comparison of cognitive-behavioral therapy and interpersonal psychotherapy for bulimia nervosa. Archives of General Psychiatry, 57, 459-466.
Halmi, Agras, Mitchell, Wilson, Crow, Bryson, & Kramer (2002) Relapse predictors of patients with bulimia nervosa who achieved abstinence through cognitive-behavioral therapy. Archives of General Psychiatry, 59, 1105-1109.
spangler_bulimia.pdf
craighead_obesity.pdf
agras_bulimia.pdf
halmi_relapse_bulimia.pdf
Craighead, Craighead, Kazdin & Mahoney (1994) Principles of Behavioral and Cognitive Change. Cognitive and Behavioral Interventions. Allyn and Bacon: Boston (pgs 29-46).
Leahy, R ( 2003) Examining and Challenging Cognitive Distortions. Cognitive Therapy Techniques. New York: Guilford. (pgs 292-305).
craighead_princlples_of_behavior_p2
leahy_examining_challenging.pdf
Beck, A, Wright, F, Newman, C & Liese, B (1993), Cognitive Therapy of Substance Abuse. (42-53).
beck_addiction.pdf
Beck, AT, Freeman, A, Davis, DD & Associates. (2004). Cognitive Therapy of Personality Disorders, (pp. 69-91). New York: Guilford Press.
beck_general_principles.pdf
Appendix A
Academic Standing Status for CSPP Doctoral Students
Use the following grade equivalencies to translate campus based to CSPP systems.
A & B = Credit with no “some concerns” or no “serious concerns”
C = marginal pass or “some concerns”
D/F = fail or “serious concerns”
In the following, substitute the grade equivalencies from above.
Good Academic Standing – Any record of performance which does not qualify for Warning, Probation, Termination, or all A and B’s.
Warning – One grade of C or lower
Probation – (a) In the first 60 units of the program: Two C’s OR one C and one D/F. (b) During the entire program: Three C’s OR one D/F and one C
Termination – Students will be terminated from the program if their GPA falls below a 3.0 or if they are on probation for 2 terms.
Related Issues:
1. Students placed on academic warning or probation status will return to good standing upon receiving of all A/B’s in the semester following the semester which qualified the person for warning/probation status.
2. Students must repeat a course for which a no credit grade is received. Both grades will remain on the transcript.
3. Students may be placed on warning, probation, or terminated for other performance, ethical or professional behavior, such as acts of misconduct, unprofessional behavior, failure to complete 67% of the units attempted every academic year, failure to complete their educational program within a reasonable period of time, or failure to pass comprehensive, preliminary, or other competency exams (Please refer to local program and system-wide polices).
4. A student may be required to take a mandatory leave of absence, a modified sequence or reduced load of courses, or to repeat or take additional courses if their academic work or professional development requires serious remediation.
Appendix B
Student Disclosure of Personal Information
(Adapted from the Student Competence Task Force of the Council of Chairs of Training Councils (CCTC), http://www.apa.org/ed/graduate/cctc.html, December 4, 2003)
Professional helpers are expected to demonstrate competence within and across a number of different but interrelated dimensions. Because programs that educate and train professional helpers also strive to protect the public and profession, faculty, training staff, and supervisors in such programs have a legitimate and vested interest in the comprehensive evaluation of student
competence to include multiple aspects of development and functioning (e.g., cognitive, emotional, psychological, interpersonal, technical, and ethical).
In CSPP, multiple aspects of students’ professional development and functioning (e.g., cognitive, emotional, psychological, interpersonal, technical, and ethical) will be evaluated throughout the process of education and training in our professional psychology and MFT programs. This kind of comprehensive evaluation is necessary in order for faculty, staff, and supervisors to appraise the professional development and competence of their students.
Faculty, staff, and supervisors have a professional, ethical, and potentially legal obligation to: (a) evaluate the interpersonal competence and emotional well being of student trainees who are under their supervision, and who provide services to clients and consumers, and (b) ensure—insofar as possible—that the trainees who complete their programs are competent to manage future relationships (e.g., client, collegial, professional, public, scholarly, supervisory, and teaching) in an effective and appropriate manner.
Faculty, staff, and supervisors will evaluate student competence in areas other than coursework, seminars, scholarship, comprehensive examinations, or related program requirements. Students may therefore be required to participate in learning activities that require different levels of self-disclosure. These multiple evaluative areas include, but are not limited to, demonstration of sufficient: (a) interpersonal and professional competence (e.g., the ways in which students relate to clients, peers, faculty, allied professionals, the public, and individuals from diverse backgrounds or histories); (b) self-awareness, self-reflection, and self-evaluation (e.g., knowledge of the content and potential impact of one's own beliefs and values on clients, peers, faculty, allied professionals, the public, and individuals from diverse backgrounds or histories); (c) openness to processes of supervision (e.g., the ability and willingness to explore issues that either interfere with the appropriate provision of care or impede professional development or functioning); and (d) resolution of problems or issues that interfere with professional development or functioning in a satisfactory manner (e.g., by responding constructively to feedback from supervisors or program faculty; by participating in personal therapy in order to resolve problems or issues).
Appendix C
I. Class Participation Grading Criteria
1. Attendance:
This is a cooperative learning class. That means that your absence affects the learning of others. In general, missing more than 2 classes will affect your class participation grade. Class participation includes actively participating in class including being adequately prepared. Your grade for class participation will be based on attendance and your good faith participation in the discussion. Being repeatedly distracted or inattentive will lower your grade.
2. Participation Examples:
Maximal Participation: Student is thoroughly prepared, contributed readily to the conversation (usually a couple of comments) but didn't dominate it; made thoughtful contributions that significantly advance the conversation (comments beyond a repeat of factual information); showed interest in and respect for other views; participated actively in small groups; raised issues related to the topic at hand, challenges participants to think about the material in new ways.
Above Average Participation: Student is prepared and makes thoughtful comments if called on; contributes occasionally without prompting; shows interest in and respect for others’ views; participates actively in small groups; while the student’s contributions are less well developed, they nevertheless advance the conversation; raised issues related to the topic at hand.
Average Participation: Student is prepared, but does not voluntarily contribute to discussions and gives only minimal answers if called on; nevertheless student show interest in the discussion, listens attentively and participates actively in small groups.
3. Types of In-Class Contributions
In general comments in the latter 2 categories will have greater value.
Fact: A statement indicating recall of the text material.
Elaboration: A comment indicating assimilation of information and ability to draw inferences, and connections between topics.
Insight: A comment suggesting penetrating discernment and understanding of the material as it relates to one’s self as a developing psychologist, a client, or the practice of psychology.
II. Case Write-Up Grading Criteria
1. Background Information
The first section of your paper will present your client’s background. Include factors such as age, gender, work, health status, family mental health history, family and social relationships, drug and alcohol history, goals, and coping skills and weaknesses.
2. Description of the Presenting Problems (aka: Problem List)
In the next section of your case study, you will describe the problem or symptoms that the client presented with. Describe any physical, emotional, or sensory symptoms reported by the client. Automatic thoughts, feelings, and behaviors associated with each problem should also be noted. Any screening or diagnostic assessments that are used should also be described in and all scores reported. Avoid diagnostic labels or historical events as problems on the problem list. Rather explain, how the historical event causing problems for the client currently.
3. Your Diagnosis
Provide your diagnosis using the appropriate DSM-IV terminology. It should be clear from the problem list how you reached your diagnosis, how the client’s symptoms fit the diagnostic criteria for the disorder(s), or any possible difficulties in reaching a diagnosis.
4. Your Formulation
Explain how a cognitive-behavioral psychologist would approach treatment. Explain how the client’s particular cognitive mechanisms; schemas (core beliefs), underlying assumptions (‘rules for living’) and behavioral mechanisms (compensatory strategies) interact with their environment in ways that generate the difficulties detailed in the problem list. Detail relevant history regarding development and maintenance of cognitive mechanisms and compensatory strategies, including how aspects of client’s environment reinforced or buffered them. Avoid providing a biographical epic, try and link each factoid to a cognitive mechanism or compensatory strategy. Include impact of culture, gender, religion, sexual-orientation, SES, etc. on development and maintenance of these cognitive structures and behavioral responses. Also include any obstacles to treatment based upon the formulation and your proposal to address or deal with them.
5. Treatment Plan
Provide a reasoned treatment plan. Be specific as to what types of interventions you propose to start with (eg: behavioral activation, cognitive restructuring, relaxation training, etc.) be sure to provide a rationale that is grounded in your formulation and cognitive-behavioral theory. Make note of expected client response and what markers would you use to gauge treatment effectiveness and when you might introduce other techniques. Also include any adjunctive treatment you might recommend and rationale as to why. Make note of any difficulties you hypothesize may be encountered by your client during treatment, tie these back to your formulation. Also discuss any adaptation or modification to standard cognitive-behavioral interventions or the session structure needed to address cultural or other issues. These should be based on your formulation.
6. Timeliness
All assignments are due by on the last class date in the syllabus. Submission can either be in person or via email. Late assignments will be accepted but will impact overall grade. When submitting by email, be sure that you receive a response from me to ensure that I have received it. The response will either be a “got it…thanks” or an automated response from my email indicating that I am out of the office and my return date. Please let me know if you are having difficulty in completing assignments on time, alternate arrangements can be made.
7. Grammar and Formatting
All assignments are expected to be typed and free from grammatical errors. Please put your name and page number in the header on each page.
8. Term Paper Examples are Available
Sample term papers can be found at: http://www.4shared.com/dir/7524049/61653c29/sharing.html
The password is andrew.
sample_term_paper_a.pdf;
sample_term_paper_harry.pdf;
sample_term_paper_l.pdf;
sample_term_paper_sylvia.pdf